Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan
Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes. The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in...
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| Veröffentlicht in: | Journal of pediatric surgery 2024-09, Vol.59 (9), p.1791-1797 |
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| creator | Uchida, Hajime Shinkai, Masato Okuyama, Hiroomi Ueno, Takehisa Inoue, Mikihiro Yasui, Toshihiro Hiyama, Eiso Kurihara, Sho Sakuma, Yasunaru Sanada, Yukihiro Taketomi, Akinobu Honda, Shohei Wada, Motoshi Ando, Ryo Fujishiro, Jun Yoshida, Mariko Yamada, Yohei Uchida, Hiroo Tainaka, Takahisa Kasahara, Mureo |
| description | Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes.
The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in Japan between 2000 and 2019 were collected for a retrospective analysis based on the state of portal vein (PV) visualization on imaging.
Among the 122 patients, 75 (61.5%) showed PV on imaging. The median age at the diagnosis was 5 months. The main complications related to CPSS were hyperammonemia (85.2%), liver masses (25.4%), hepatopulmonary shunts (13.9%), and pulmonary hypertension (11.5%). The prevalence of complications was significantly higher in patients without PV visualization than in those with PV visualization (P |
| doi_str_mv | 10.1016/j.jpedsurg.2024.05.008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3065276934</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0022346824003099</els_id><sourcerecordid>3065276934</sourcerecordid><originalsourceid>FETCH-LOGICAL-c245t-bd901206e9a9eff8d06f545101bca01d4a310bcb13565d9cd336f3cf778bcb633</originalsourceid><addsrcrecordid>eNqFkEFv1DAQhS0EokvhL1Q-ckkYx4k34US1aqGoqJUK4mg59mTXq8RebKdoj_xzHG3LldNIb957o_kIuWBQMmDiw77cH9DEOWzLCqq6hKYEaF-QFWs4Kxrg65dkBVBVBa9Fe0bexLgHyDKw1-SMty3vatGtyJ-b6aB0on6g9z4kNdLr0f-m3tG0Q3of_Nb5aOOy3-zsaAI6-tOmHd14t0Vnl8QS9PEYE05W04fd7NJHekm_zWOyGl0KWb3rI4ZHlWxufkizOVLr6Fd1UO4teTWoMeK7p3lOflxffd98KW7vPt9sLm8LXdVNKnrTAatAYKc6HIbWgBiauskweq2AmVpxBr3uGW9EYzptOBcD18N63WZVcH5O3p96D8H_mjEmOdmocRyVQz9HyUE01Vp0vM5WcbLq4GMMOMhDsJMKR8lALvjlXj7jlwt-CY3M-HPw4unG3E9o_sWeeWfDp5MB86ePFoOM2qLTaGxAnaTx9n83_gK-8pvj</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3065276934</pqid></control><display><type>article</type><title>Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Uchida, Hajime ; Shinkai, Masato ; Okuyama, Hiroomi ; Ueno, Takehisa ; Inoue, Mikihiro ; Yasui, Toshihiro ; Hiyama, Eiso ; Kurihara, Sho ; Sakuma, Yasunaru ; Sanada, Yukihiro ; Taketomi, Akinobu ; Honda, Shohei ; Wada, Motoshi ; Ando, Ryo ; Fujishiro, Jun ; Yoshida, Mariko ; Yamada, Yohei ; Uchida, Hiroo ; Tainaka, Takahisa ; Kasahara, Mureo</creator><creatorcontrib>Uchida, Hajime ; Shinkai, Masato ; Okuyama, Hiroomi ; Ueno, Takehisa ; Inoue, Mikihiro ; Yasui, Toshihiro ; Hiyama, Eiso ; Kurihara, Sho ; Sakuma, Yasunaru ; Sanada, Yukihiro ; Taketomi, Akinobu ; Honda, Shohei ; Wada, Motoshi ; Ando, Ryo ; Fujishiro, Jun ; Yoshida, Mariko ; Yamada, Yohei ; Uchida, Hiroo ; Tainaka, Takahisa ; Kasahara, Mureo ; Japanese Society of Pediatric Splenology and Portalvenology</creatorcontrib><description>Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes.
The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in Japan between 2000 and 2019 were collected for a retrospective analysis based on the state of portal vein (PV) visualization on imaging.
Among the 122 patients, 75 (61.5%) showed PV on imaging. The median age at the diagnosis was 5 months. The main complications related to CPSS were hyperammonemia (85.2%), liver masses (25.4%), hepatopulmonary shunts (13.9%), and pulmonary hypertension (11.5%). The prevalence of complications was significantly higher in patients without PV visualization than in those with PV visualization (P < 0.001). Overall, 91 patients (74.6%) received treatment, including shunt closure by surgery or interventional radiology (n = 82) and liver transplantation (LT) or liver resection (n = 9). Over the past 20 years, there has been a decrease in the number of patients undergoing LT. Although most patients showed improvement or reduced progression of symptoms, liver masses and pulmonary hypertension were less likely to improve after shunt closure. Complications related to shunt closure were more likely to occur in patients without PV visualization (P = 0.001). In 25 patients (20.5%) without treatment, those without PV visualization were significantly more likely to develop complications related to CPSS than those with PV visualization (P = 0.011).
Patients without PV visualization develop CPSS-related complications and, early treatment using prophylactic approaches should be considered, even if they are asymptomatic.
Level III.
•What is currently known about this topic?
A congenital portosystemic shunt is a rare disease with diverse manifestations and is divided into intra- and extrahepatic shuts. However, it has been mainly mentioned in case reports or small series with short-term follow-up.•What new information is contained in this article?
This study focuses on the impact of portal flow on the prognosis of children with congenital portosystemic shunts. Patients without delineation of the portal vein system tend to develop more shunt-related symptoms and are more prone to portal hypertension-related complications after shunt closure.</description><identifier>ISSN: 0022-3468</identifier><identifier>ISSN: 1531-5037</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2024.05.008</identifier><identifier>PMID: 38839469</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Japan - epidemiology ; Liver Transplantation ; Male ; Portal hypertension ; Portal vein ; Portal Vein - abnormalities ; Portopulmonary hypertension ; Portosystemic shunt ; Prognosis ; Retrospective Studies ; Vascular Malformations - epidemiology ; Vascular Malformations - surgery</subject><ispartof>Journal of pediatric surgery, 2024-09, Vol.59 (9), p.1791-1797</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c245t-bd901206e9a9eff8d06f545101bca01d4a310bcb13565d9cd336f3cf778bcb633</cites><orcidid>0000-0001-9179-5037 ; 0000-0001-7927-1038 ; 0000-0002-3965-2087 ; 0000-0002-1347-282X ; 0000-0001-9451-8318 ; 0000-0003-1366-8504 ; 0000-0002-5238-3678 ; 0000-0001-6059-7660 ; 0000-0003-2441-5158</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpedsurg.2024.05.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38839469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Uchida, Hajime</creatorcontrib><creatorcontrib>Shinkai, Masato</creatorcontrib><creatorcontrib>Okuyama, Hiroomi</creatorcontrib><creatorcontrib>Ueno, Takehisa</creatorcontrib><creatorcontrib>Inoue, Mikihiro</creatorcontrib><creatorcontrib>Yasui, Toshihiro</creatorcontrib><creatorcontrib>Hiyama, Eiso</creatorcontrib><creatorcontrib>Kurihara, Sho</creatorcontrib><creatorcontrib>Sakuma, Yasunaru</creatorcontrib><creatorcontrib>Sanada, Yukihiro</creatorcontrib><creatorcontrib>Taketomi, Akinobu</creatorcontrib><creatorcontrib>Honda, Shohei</creatorcontrib><creatorcontrib>Wada, Motoshi</creatorcontrib><creatorcontrib>Ando, Ryo</creatorcontrib><creatorcontrib>Fujishiro, Jun</creatorcontrib><creatorcontrib>Yoshida, Mariko</creatorcontrib><creatorcontrib>Yamada, Yohei</creatorcontrib><creatorcontrib>Uchida, Hiroo</creatorcontrib><creatorcontrib>Tainaka, Takahisa</creatorcontrib><creatorcontrib>Kasahara, Mureo</creatorcontrib><creatorcontrib>Japanese Society of Pediatric Splenology and Portalvenology</creatorcontrib><title>Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes.
The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in Japan between 2000 and 2019 were collected for a retrospective analysis based on the state of portal vein (PV) visualization on imaging.
Among the 122 patients, 75 (61.5%) showed PV on imaging. The median age at the diagnosis was 5 months. The main complications related to CPSS were hyperammonemia (85.2%), liver masses (25.4%), hepatopulmonary shunts (13.9%), and pulmonary hypertension (11.5%). The prevalence of complications was significantly higher in patients without PV visualization than in those with PV visualization (P < 0.001). Overall, 91 patients (74.6%) received treatment, including shunt closure by surgery or interventional radiology (n = 82) and liver transplantation (LT) or liver resection (n = 9). Over the past 20 years, there has been a decrease in the number of patients undergoing LT. Although most patients showed improvement or reduced progression of symptoms, liver masses and pulmonary hypertension were less likely to improve after shunt closure. Complications related to shunt closure were more likely to occur in patients without PV visualization (P = 0.001). In 25 patients (20.5%) without treatment, those without PV visualization were significantly more likely to develop complications related to CPSS than those with PV visualization (P = 0.011).
Patients without PV visualization develop CPSS-related complications and, early treatment using prophylactic approaches should be considered, even if they are asymptomatic.
Level III.
•What is currently known about this topic?
A congenital portosystemic shunt is a rare disease with diverse manifestations and is divided into intra- and extrahepatic shuts. However, it has been mainly mentioned in case reports or small series with short-term follow-up.•What new information is contained in this article?
This study focuses on the impact of portal flow on the prognosis of children with congenital portosystemic shunts. Patients without delineation of the portal vein system tend to develop more shunt-related symptoms and are more prone to portal hypertension-related complications after shunt closure.</description><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Japan - epidemiology</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Portal hypertension</subject><subject>Portal vein</subject><subject>Portal Vein - abnormalities</subject><subject>Portopulmonary hypertension</subject><subject>Portosystemic shunt</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Vascular Malformations - epidemiology</subject><subject>Vascular Malformations - surgery</subject><issn>0022-3468</issn><issn>1531-5037</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEFv1DAQhS0EokvhL1Q-ckkYx4k34US1aqGoqJUK4mg59mTXq8RebKdoj_xzHG3LldNIb957o_kIuWBQMmDiw77cH9DEOWzLCqq6hKYEaF-QFWs4Kxrg65dkBVBVBa9Fe0bexLgHyDKw1-SMty3vatGtyJ-b6aB0on6g9z4kNdLr0f-m3tG0Q3of_Nb5aOOy3-zsaAI6-tOmHd14t0Vnl8QS9PEYE05W04fd7NJHekm_zWOyGl0KWb3rI4ZHlWxufkizOVLr6Fd1UO4teTWoMeK7p3lOflxffd98KW7vPt9sLm8LXdVNKnrTAatAYKc6HIbWgBiauskweq2AmVpxBr3uGW9EYzptOBcD18N63WZVcH5O3p96D8H_mjEmOdmocRyVQz9HyUE01Vp0vM5WcbLq4GMMOMhDsJMKR8lALvjlXj7jlwt-CY3M-HPw4unG3E9o_sWeeWfDp5MB86ePFoOM2qLTaGxAnaTx9n83_gK-8pvj</recordid><startdate>202409</startdate><enddate>202409</enddate><creator>Uchida, Hajime</creator><creator>Shinkai, Masato</creator><creator>Okuyama, Hiroomi</creator><creator>Ueno, Takehisa</creator><creator>Inoue, Mikihiro</creator><creator>Yasui, Toshihiro</creator><creator>Hiyama, Eiso</creator><creator>Kurihara, Sho</creator><creator>Sakuma, Yasunaru</creator><creator>Sanada, Yukihiro</creator><creator>Taketomi, Akinobu</creator><creator>Honda, Shohei</creator><creator>Wada, Motoshi</creator><creator>Ando, Ryo</creator><creator>Fujishiro, Jun</creator><creator>Yoshida, Mariko</creator><creator>Yamada, Yohei</creator><creator>Uchida, Hiroo</creator><creator>Tainaka, Takahisa</creator><creator>Kasahara, Mureo</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9179-5037</orcidid><orcidid>https://orcid.org/0000-0001-7927-1038</orcidid><orcidid>https://orcid.org/0000-0002-3965-2087</orcidid><orcidid>https://orcid.org/0000-0002-1347-282X</orcidid><orcidid>https://orcid.org/0000-0001-9451-8318</orcidid><orcidid>https://orcid.org/0000-0003-1366-8504</orcidid><orcidid>https://orcid.org/0000-0002-5238-3678</orcidid><orcidid>https://orcid.org/0000-0001-6059-7660</orcidid><orcidid>https://orcid.org/0000-0003-2441-5158</orcidid></search><sort><creationdate>202409</creationdate><title>Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan</title><author>Uchida, Hajime ; Shinkai, Masato ; Okuyama, Hiroomi ; Ueno, Takehisa ; Inoue, Mikihiro ; Yasui, Toshihiro ; Hiyama, Eiso ; Kurihara, Sho ; Sakuma, Yasunaru ; Sanada, Yukihiro ; Taketomi, Akinobu ; Honda, Shohei ; Wada, Motoshi ; Ando, Ryo ; Fujishiro, Jun ; Yoshida, Mariko ; Yamada, Yohei ; Uchida, Hiroo ; Tainaka, Takahisa ; Kasahara, Mureo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c245t-bd901206e9a9eff8d06f545101bca01d4a310bcb13565d9cd336f3cf778bcb633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Japan - epidemiology</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Portal hypertension</topic><topic>Portal vein</topic><topic>Portal Vein - abnormalities</topic><topic>Portopulmonary hypertension</topic><topic>Portosystemic shunt</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Vascular Malformations - epidemiology</topic><topic>Vascular Malformations - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Uchida, Hajime</creatorcontrib><creatorcontrib>Shinkai, Masato</creatorcontrib><creatorcontrib>Okuyama, Hiroomi</creatorcontrib><creatorcontrib>Ueno, Takehisa</creatorcontrib><creatorcontrib>Inoue, Mikihiro</creatorcontrib><creatorcontrib>Yasui, Toshihiro</creatorcontrib><creatorcontrib>Hiyama, Eiso</creatorcontrib><creatorcontrib>Kurihara, Sho</creatorcontrib><creatorcontrib>Sakuma, Yasunaru</creatorcontrib><creatorcontrib>Sanada, Yukihiro</creatorcontrib><creatorcontrib>Taketomi, Akinobu</creatorcontrib><creatorcontrib>Honda, Shohei</creatorcontrib><creatorcontrib>Wada, Motoshi</creatorcontrib><creatorcontrib>Ando, Ryo</creatorcontrib><creatorcontrib>Fujishiro, Jun</creatorcontrib><creatorcontrib>Yoshida, Mariko</creatorcontrib><creatorcontrib>Yamada, Yohei</creatorcontrib><creatorcontrib>Uchida, Hiroo</creatorcontrib><creatorcontrib>Tainaka, Takahisa</creatorcontrib><creatorcontrib>Kasahara, Mureo</creatorcontrib><creatorcontrib>Japanese Society of Pediatric Splenology and Portalvenology</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Uchida, Hajime</au><au>Shinkai, Masato</au><au>Okuyama, Hiroomi</au><au>Ueno, Takehisa</au><au>Inoue, Mikihiro</au><au>Yasui, Toshihiro</au><au>Hiyama, Eiso</au><au>Kurihara, Sho</au><au>Sakuma, Yasunaru</au><au>Sanada, Yukihiro</au><au>Taketomi, Akinobu</au><au>Honda, Shohei</au><au>Wada, Motoshi</au><au>Ando, Ryo</au><au>Fujishiro, Jun</au><au>Yoshida, Mariko</au><au>Yamada, Yohei</au><au>Uchida, Hiroo</au><au>Tainaka, Takahisa</au><au>Kasahara, Mureo</au><aucorp>Japanese Society of Pediatric Splenology and Portalvenology</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2024-09</date><risdate>2024</risdate><volume>59</volume><issue>9</issue><spage>1791</spage><epage>1797</epage><pages>1791-1797</pages><issn>0022-3468</issn><issn>1531-5037</issn><eissn>1531-5037</eissn><abstract>Although congenital portosystemic shunts (CPSSs) are increasingly being recognized, the optimal treatment strategies and natural prognosis remain unclear, as individual CPSSs show different phenotypes.
The medical records of 122 patients who were diagnosed with CPSSs at 15 participating hospitals in Japan between 2000 and 2019 were collected for a retrospective analysis based on the state of portal vein (PV) visualization on imaging.
Among the 122 patients, 75 (61.5%) showed PV on imaging. The median age at the diagnosis was 5 months. The main complications related to CPSS were hyperammonemia (85.2%), liver masses (25.4%), hepatopulmonary shunts (13.9%), and pulmonary hypertension (11.5%). The prevalence of complications was significantly higher in patients without PV visualization than in those with PV visualization (P < 0.001). Overall, 91 patients (74.6%) received treatment, including shunt closure by surgery or interventional radiology (n = 82) and liver transplantation (LT) or liver resection (n = 9). Over the past 20 years, there has been a decrease in the number of patients undergoing LT. Although most patients showed improvement or reduced progression of symptoms, liver masses and pulmonary hypertension were less likely to improve after shunt closure. Complications related to shunt closure were more likely to occur in patients without PV visualization (P = 0.001). In 25 patients (20.5%) without treatment, those without PV visualization were significantly more likely to develop complications related to CPSS than those with PV visualization (P = 0.011).
Patients without PV visualization develop CPSS-related complications and, early treatment using prophylactic approaches should be considered, even if they are asymptomatic.
Level III.
•What is currently known about this topic?
A congenital portosystemic shunt is a rare disease with diverse manifestations and is divided into intra- and extrahepatic shuts. However, it has been mainly mentioned in case reports or small series with short-term follow-up.•What new information is contained in this article?
This study focuses on the impact of portal flow on the prognosis of children with congenital portosystemic shunts. Patients without delineation of the portal vein system tend to develop more shunt-related symptoms and are more prone to portal hypertension-related complications after shunt closure.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38839469</pmid><doi>10.1016/j.jpedsurg.2024.05.008</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9179-5037</orcidid><orcidid>https://orcid.org/0000-0001-7927-1038</orcidid><orcidid>https://orcid.org/0000-0002-3965-2087</orcidid><orcidid>https://orcid.org/0000-0002-1347-282X</orcidid><orcidid>https://orcid.org/0000-0001-9451-8318</orcidid><orcidid>https://orcid.org/0000-0003-1366-8504</orcidid><orcidid>https://orcid.org/0000-0002-5238-3678</orcidid><orcidid>https://orcid.org/0000-0001-6059-7660</orcidid><orcidid>https://orcid.org/0000-0003-2441-5158</orcidid></addata></record> |
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| ispartof | Journal of pediatric surgery, 2024-09, Vol.59 (9), p.1791-1797 |
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| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Child Child, Preschool Female Humans Infant Infant, Newborn Japan - epidemiology Liver Transplantation Male Portal hypertension Portal vein Portal Vein - abnormalities Portopulmonary hypertension Portosystemic shunt Prognosis Retrospective Studies Vascular Malformations - epidemiology Vascular Malformations - surgery |
| title | Impact of Portal Flow on the Prognosis of Children With Congenital Portosystemic Shunt: A Multicentric Observation Study in Japan |
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